SUN-345 - Military Service Members on Methimazole

Introduction

The military faces unique challenges in managing Graves' disease, particularly with antithyroid medications, as service members deploy to remote locations with limited medical resources. Variable approaches to medical and logistical challenges have caused confusion and inconsistency.

Methods

A survey was administered to 21 endocrinologists from the Army, Navy, and Air Force addressing the following questions:

1. Should service members with Graves' disease on methimazole be considered worldwide deployable?
2. If not, when should they be referred for a Medical Evaluation Board (MEB)?
3. Should TSI-negative service members who have weaned off methimazole be considered worldwide deployable?
4. Should applicants with a history of Graves' disease treated with methimazole be granted waivers to enlist?
5. Do opinions differ by branch of service?

Data were analyzed using qualitative thematic analysis.

Results

19/21 surveys were completed.

Question 1:
No respondents supported worldwide deployability for service members on methimazole, at least initially. A minority (4/19) considered it possible if thyroid function was stable for ≥1 year and methimazole dose was ≤10 mg/day. Concerns included lack of access to thyroid function testing, inconsistent pharmacy supply, adverse drug reactions, nonadherence, limited physician availability, and Graves' disease exacerbations due to deployment stress.

Question 2:
Most (10/19) would refer patients to an MEB after one year on methimazole, 2/19 would refer sooner, and 7/19 would defer to primary care or the military unit.

Question 3:
Most (16/19) considered deployment reasonable for TSI-negative service members off methimazole, with stipulations including stable thyroid function duration and access to testing and pharmacy supply. A minority (2/19) opposed deployment.

Question 4:
Some (11/19) supported military accession, though 6 required prolonged stable thyroid function. Others (5/19) recommended against accession, and 2/19 considered it only for applicants with difficult-to-recruit skills.

Question 5:
Some (7/19) noted Air Force deployments often occur in areas with better medical resources, while 6/19 highlighted the difficulty of evacuation at sea for Navy personnel.

Conclusion
Service members who select antithyroid medication to treat Graves' disease should have deployment location restrictions. While this may result in separation from the military, it is essential for patient safety and operational readiness.

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